Bone

Healing
Process
Group 7

Leong Wing Yen Jovinia

Vanessa Sharon
Yoharena Nur Fatin
 WHAT IS BONE ?

Bone is essentially a highly vascular, living, constantly

changing mineralized connective tissue which makes up
bodys skeleton.
Other functions are:
-Bone provides protection for the vital organs of the body
(eg: heart and brain)
-The hematopoietic bone marrow is protected by the
surrounding bony tissue.
- Storage of calcium and phosphate.
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 MACROSCOPY
Spongy bone (cancellous) : is composed of a lattice or
network of branching bone spicules or trabeculae. The spaces
between the bone spicules contain bone marrow.
Compact bone (cortical / outer): appears as a mass of bony
tissue lacking spaces visible to the unaided eye.

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 MICROSCOPY
Woven (Immature bone): Characterized by random
arrangement of cells and collagen ,associated with periods of
rapid bone formation, such as in initial stage of fracture healing.
Lamellar bone (Mature bone) : Characterized by an orderly
cellular distribution and properly oriented collagen fibres . This
constitutes organised bone both cortical and cancellous.
Components of BONE Formation

Cortex

Periosteum

Bone marrow

Soft tissue
Cell of bone
Stages of bone healing
Inflammation (Hematoma formation)
Torn blood vessels
hemorrhage
A mass of clotted
blood (hematoma)
forms at the
fracture site
Site becomes swollen,
painful, and inflamed
Inflammation (Cellular Proliferation)
Within 8 hours inflammatory reaction
starts.
Proliferation and Differentiation of
mesenchymal stem cells -cells that can
differentiate into a variety of cell types
eg. osteoblasts (bone cells),
chondrocytes (cartilage cells),
myocytes (muscle cells) and adipocytes
(fat cells which give rise to marrow
adipose tissue).
Secretion of TGF-B , PDGF and various
BMP factors (growth factors for bone
growth and repair).
 Repair (Soft Callus Formation)
Fibrocartilaginous callus forms
Osteoblasts and fibroblasts migrate to the
fracture and begin reconstructing the bone
Fibroblasts secrete collagen fibers that
connect broken bone ends
Osteoblasts begin forming spongy bone
Osteoblasts furthest from capillaries secrete
an externally bulging cartilaginous matrix that
later calcifies
Granulation tissue (soft callus) forms a few
days after the fracture
Capillaries grow into the tissue and
phagocytic cells begin cleaning debris
 Repair (Hard Callus Formation)
New bone trabeculae appear
in the fibrocartilaginous
callus
Fibrocartilaginous callus
converts into a bony (hard)
callus
Bone callus begins 3-4 weeks
after injury, and continues
until firm union is formed 2-
3 months later
 Remodelling
Excess material on the bone
shaft exterior and in the
medullary canal is removed
Compact bone is laid down
to reconstruct shaft walls
Types of bone healing
1. Direct (primary)bone healing
2. Indirect (secondary)bone healing
 Direct (Primary)
Direct attempt by the cortex to re-establish itself after interruption
without the formation of callus
It only works when the edges are touching exactly. Its is the less
commonly seen type of healing
Contact healing: When there is direct contact between the cortical bone ends,
lamellar bones forms directly across the fracture line.
Gap healing: When the osteoblast differentiate and start depositing osteoid on
the exposed surfaces o fragment ends.
Gaps less than 0.5mm are primarily filled with woven bone that is subsequently
remodelled into lamellar bone
Larger gaps are healed by indirect bone healing (partially filled with fibrous
tissue that undergoes secondary ossification)
 Indirect (Secondary)
It is usual type consisting of formation of callus either of
cartilaginous or fibrous. This callus is later replaced by
lamellar bone. It is comparable to healing of soft tissue
by filling of gaps with vascular granulation tissue.
Involves the classical stages of injury, haemorrhage
inflammation ,primary soft callus formation, callus
mineralization and callus remodelling.
Presences of inter-fragmentary gap - Malunion, Fibrous
union(Non-union), Infection
 Summary
-FORMATION OF HAEMATOMA
BETWEEN THE END OF BONE
AND SURROUND SOFT TISSUE
-RESHAPING OF BONE CONTINUE AND
GRADUALLY MEDULLARY CANAL IS
REOPENED THROUGH THE CALLUS (IN
WEEKS/MONTH )
-CALLUS TISSUE COMPLETELY REPLACED
WITH MATURE COMPACT BONE & THE
BONE IS THICKER AND STRONGER AT
REPAIR SITE THAN ORIGINALLY.
-DEAD BONE & TISSUE FRAGMENTS
REMOVED BY PHAGOCYTOSIS.
-FIBROBLASTS MIGRATE TO THE
SITE,GRANULATION TISSUE AND NEW
CAPILLARIES DEVELOP
-OSTEOBLASTS SECRETE SPONGY
BONE WHICH UNITES THE BROKEN
END PRO TECTED BY OUTER LAYER
OF BONE & CARTILAGE.
-NEW DEPOSITS OF BONE &
CARTILAGE IS CALLED CALLUS.
STAGES OF BONE HEALING